by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer

March 26, 2024

Featured Literature:

McCartney EM, Ralton L, Dawe J, et al on behalf of the EC Australia partnership.  Point of care testing for hepatitis C in the priority settings of mental health, prisons and drug & alcohol facilities – the PROMPt Study.  2024 Mar 21:ciae155.  doi: 10.1093/cid/ciae155.  PMID: 38513072. 

PROMPt was a prospective cohort study evaluating point of care HCV antibody and RNA on testing rates and acceptability, linkage to care, and treatment in three priority settings: prison, an inpatient alcohol and drug unit, and inpatient mental health services in South Australia.  Study teams (composed of HCV-experienced nurses and peer educators) provided pre- and post-test counseling, harm reduction education, and administered point of care testing (POCT).  The HCV antibody screen utilized 10µl capillary whole blood; participants with positive antibody result were offered an RNA test (100µl capillary whole blood); participants with detectable HCV RNA were linked to care with the local viral hepatitis nurse service.  Among 1,549 participants, 98% indicated a preference for same-day HCV POCT compared to standard venipuncture and lab/instrument-based testing.  264 (17%) tested antibody positive and 100% underwent reflexive RNA testing, with 55 (4% overall, 21% of antibody-positive participants) testing RNA positive.  Across all three settings, there was an approximate three-fold increase in the rate of HCV antibody testing per year (and two-fold increase in RNA testing) in the intervention period compared to the historical control period, largely driven by increases in the inpatient alcohol and drug unit setting.  For the 55 RNA-positive participants, 91% were linked to care and 86% initiated treatment; median time from referral to treatment was 14 days.

Author’s Commentary:

Streamlined HCV screening and testing can facilitate linkage to care, especially among populations that might not routinely access traditional “brick and mortar” clinics.  These PROMPt Study results demonstrate that combined point of care antibody and RNA testing, delivered by interprofessional nursing and peer educator teams, are highly acceptable among individuals in priority settings and can expedite linkage to additional HCV care and treatment.  Interventions such as these are necessary to help address the various systems-level and structural challenges which have precluded optimal integration and implementation of HCV elimination efforts.  

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